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Provider Entity Registration

Provider Entity Registration

Entity Application Packet

Nursing Home and IID

The link above is to provide Provider Entities access to the necessary application, documents and other forms needed for obtaining a Tennessee Medicaid ID or updating your existing Medicaid ID. If you are a provider person or Group (single / multi-specialty) please return to provider home page and select the appropriate link.

For provider entities, complete the information in the application packet and submit to:

Provider Registration
310 Great Circle Road
Nashville, TN 37243

To avoid processing delays, please ensure you submit a complete packet. A checklist is included to provide information regarding what is needed.

The ACH forms in the packet contain information on where to send the completed electronic payment documents. For more information on ACH electronic payments, click on ACH Information.